The Eden Alternative™ -- Renewing Life in Nursing
As the U.S. population ages, many of us will become consumers of
long term care. We may need to put our parents in residential settings,
or to find assisted living for ourselves. Luckily, a new philosophy
is sweeping the nation's nursing homes, one that offers a "life
worth living" inside long term care. It's called the Eden Alternative.
One of a handful of pioneering approaches to reforming the long term care
industry, the Eden Alternative was created in 1991. Dr. William
H. Thomas, his wife Judy Meyers Thomas and the administrative team
at Chase Memorial Nursing Home in upstate New York sought a new
paradigm of care for the residents of the rural nursing home. They
found inspiration in nature. As Dr. Thomas wrote, the vision went
something like this: "We'll bring in 100 birds, two dogs, four cats,
three rabbits and a flock of laying hens…Then we'll plow the lawn
and start a large organic vegetable garden outside our residents'
Many nursing homes would have farmed this vision out to a committee, but
not Chase. One day, the birds arrived--all 100 of them! The result
was pandemonium. From that day, the definition of long term care
was changed forever. Did it happen easily? No. Several staff members
could not accept or adapt to change, and left. Others complained.
Some of the loudest voices were residents who didn't want pets!
But the birds went to work, and the naysayers became the greatest
advocates of a "new way."
The results of this vision were significant. At Chase Memorial, during the
implementation of the Eden Alternative, research showed a reduction
in a) overall number of drug prescriptions, b) infection rates,
c) staff turnover, and d) the mortality rate. Savings on drug prescriptions
were allocated to maintaining the Eden environment. Studies of the
Texas Eden Alternative Project at several nursing homes charted
significant decreases in a) in-house pressure sores, b) PRN (anxiolytic
and antidepressant) medications, and c) staff absenteeism. Finally,
the best indicator of success is census count. Eden Alternative
homes across the nation report waiting lists for their beds.
A Day in an Eden Alternative Home
You notice something different about an Eden home before you enter
the door. It might be a winding garden path, an attractive landscape,
or playground equipment in the front yard. You may see birds at a
feeder or hear a donkey braying, even in an urban neighborhood!
When you enter the building, something else catches your senses-the
tantalizing aroma of a good meal. You may hear the conversation
of children, watch the flight of finches in an aviary, or revel
in the richness of lush house plants, paintings, pictures, photographs
and schoolwork on the walls. Everything reminds you of home.
|Chicquita the Conure "gives a kiss."
Many residents awaken to the sound of birdsong, because there are parakeets
in nearly every room. Every day, the "birdmobile" (a converted medication
cart) makes the rounds of rooms, with food and supplies. At Chase
Memorial, the birdmobile is manned by volunteers from a local middle
school. The kids enjoy interacting with the birds and their owners.
Once awake, a person might choose to have a cup of coffee, or tea.
Or they might decide to have breakfast in the dining room. Many Eden
Alternative homes have open hours for dining. The homes may offer
a buffet, so residents have a choice of when and what they eat. In
the Eden Alternative home, the activities schedule has been altered
to reflect the natural rhythms of home life. Rather than hunting for
residents for the programmed activities, the activity department staff
are helping residents care for the tame rabbits and hedgehogs, the
cats and guinea pigs. You can imagine the excitement when the hamster
|Children and pets are naturals in an Eden Home.
Residents may decide to walk or pet the dogs, or to visit with
the children in the on-site child care center. At lunch, they sit
with their friends. They may enjoy tomatoes harvested from the nursing
home's gardens. They may decide to take a nap, join a group of friends
for a game of cards, or work in the garden for a while.
The Garden of Eden
The gardens are designed for accessibility. As Dr. Thomas writes, "Elderly
residents cannot and should not have to climb over misplaced obstacles
or reach into a flower or vegetable bed that's too wide." Walks
are paved for wheelchairs. Raised beds, benches and shade are all
important components of the garden. The most crucial aspect of the
Eden Alternative garden, however, should never be overlooked: it
must be inviting and available-not a showplace, not a well-trimmed
yard, but a natural retreat for everyone at the nursing home. It
should never be "off limits." Many Eden homes combine gardens and
playgrounds, so that residents may watch the children at play. A
well-equipped playground encourages visitors. Before you know it,
families are bringing their young ones to see grandma.
The Zachary Test
If you are looking for a nursing home, give it the Zachary Test. One day
Dr. Thomas took his son Zachary to visit a nursing home. On the
way, he writes in Life Worth Living, "the conversation went something
Zach: When we get there I'm going to play with the kids.
Dad: They don't have any kids there, Zach.
Zach: Well, I'll play with the dogs then.
Dad: They don't have any dogs.
Zach: But I can help feed the birds, right?
Dad: Sorry, they don't have any birds.
Zach: I'll play with the people (residents). That will
Dad: Maybe…we'll see.
Zach (in a disappointed voice): Dad I thought we were going
to a nursing home.
Making It Happen-The First Step
The very first step in creating an Eden Alternative environment starts with
the resident. It's similar to "person-centered planning," where
all care considerations focus on the needs of the resident-a far
cry from the status quo.
What is it about nursing homes that is so disturbing? Dr. Thomas writes that
nursing homes are built on a medical model of care, much like hospitals.
Staff are arranged in a hierarchy with administrators, doctors and
nurses at the top and nursing assistants-the people who actually
care for residents-at the bottom. The Eden Alternative replaces
the medical model with a "human habitat" giving real responsibility
to the people who spend the most time with residents.
You could argue that our greatest fear is to leave our homes and go
to a place where we will receive intimate nursing care from strangers.
How do you assuage this fear? To build relationships (the cornerstone
of care), the Eden Alternative home has permanent nursing care teams.
Each team is responsible for a small number of residents, as well
as the operation of their work units. For instance, in an Eden Alternative
home, the certified nurse assistants (CNAs) prepare their own schedules
and daily assignments. Changing this single aspect of nursing care-creating
permanent care teams-has produced a reward: staff turnover is reduced,
and the staff members and residents are much happier.
|Toddler hoops grace an Eden garden.
Jeanette Reisinger, RN, a team coordinator at Good Shepherd Care Center in
Versailles, MO, says that continuity of care helps nursing assistants
and residents become "like a family." Good Shepherd incorporates
the Eden Alternative into new employee orientation and ongoing weekly
team meetings. Nursing staff are not assigned to units; they must
"apply" and be accepted for the team of their choice.
An Eden team includes everyone who comes into contact with the residents-the
housekeepers, activity, laundry, maintenance and rehab staff. Staff
members quickly learn to make decisions based on the residents'
needs, and to work cooperatively for that end. Teams elect their
own leaders; usually the administrator, Eden Coordinator or nurses
act as consultants to the permanent care teams.
Three Plagues of Nursing Homes
Dr. Thomas write that people in nursing homes face a prevalent disease. Heart
disease? Diabetes? Parkinson's or Alzheimer's? Ironically, this
is a disease of the heart, with three important symptoms: loneliness,
helplessness and boredom. Let's see how the Eden Alternative environment
combats these "plagues."
The cure for loneliness is companionship. That's where the birds come in.
As pets, parakeets are lively, responsive and bond with their owners.
At Chase Memorial, those who didn't want a parakeet soon changed
Dogs and cats are important members of the Eden Alternative home. We all
know that there are dog people and there are cat people-why should
we leave that aside when we move to assisted care? Eden homes report
that people respond warmly, and sometimes surprisingly, to cats
and dogs. Pets get people talking, and involved in their environment.
The stories are legend: how a man who hadn't uttered a word in months
said, "Nice doggie." How a woman with dementia "adopted" the birdmobile
and quit wandering. How another woman, who had partial paralysis,
moved her hand to stroke a cat.
In the United States, two highly segregated populations are children and
elders. Children are sent off to schools with their peers. Elders
are sent to nursing homes full of their peers. The Eden Alternative
home strives to keep the family together. What better way than to
offer on-site child care to staff members? And to include children
of all ages in the daily lives of residents? Sharing stories, playing
games, helping with homework, working together in the garden, holding
a baby- all are simple ways to bring generations together.
By helping children, and caring for pets and plants, elders overcome feelings
of helplessness. They are, in a real way, giving care when they
make decisions about their environment and the people around them.
Finally, a home that opens its doors to pets, children and the community
has little room for boredom. What happens when the cat goes after
the cockatiel? When the dog chases a rabbit across the garden? When
a finch flies out of the aviary? The unexpected! Life in an Eden
home is spontaneous. The team on Unit 3 may decide to cook spaghetti
for dinner. Or the Blue team is having a garage sale. The folks
in the Rose Arbor are going out for a show. Or residents at West
Hall are mixing up cucumber pickles. The kids have a day off school
and the home is full of young volunteers.
A final note-you would not expect conformity in an Eden home, either. How
do you tell the difference between residents' rooms? Well, they've
brought their own furniture, their favorite artwork and photographs.
The rooms are painted in their favorite colors, and they decide
how to decorate the halls. Each Eden home is different, as Johanne
Buck, Activities Coordinator at Spruce Lodge, "shares a defining
moment. It was the moment when, she says, she knew it was really
a home in the best traditional sense of the word. 'I came walking
into the living room, and there was a resident asleep on the couch,
one arm draped over the side, her fingers resting on the head of
our daily visitor Max, a gentle golden mutt, who was also happily
Eden Alternative Principles
An "Edenizing" home adopts "Ten Principles." These include: "surrendering
the institutional point of view" and adopting the "human habitat
model that makes pets, plants and children the pivots for daily
life in a nursing home." An Eden home "provides easy access to companionship,"
"provides opportunities to give as well as to receive care," and
"imbues daily life with variety and spontaneity." Moreover, the
Eden Alternative home replaces programmed activities with natural
activities of daily life.
|Young volunteers bring smiles.
How does a nursing home become an Eden Alternative home? Today,
certification assures that the residents, owners, administrators,
families and staff are committed to the Eden Alternative. The administrator
and other staff members are trained as Eden Associates, and receive
ongoing advice. Each step of the process-and it is a process, not
a marketing ploy-is acknowledged. In an Eden Alternative home, "change
is good." The Eden community supports every effort by forming regional
coalitions, and stays in close contact through discussion groups
on the Eden web site.
Eden Alternative Resources
742 Turnpike Road
Sherburne, NY 13460.
Life Worth Living: How Someone You Love Can Still Enjoy Life in a Nursing
Home by William H. Thomas, M.D. VanderWyk & Burnam. 1996. Available
Learning from Hannah. 1999. Available from Eden Alternative Online
The Eden Journal. Quarterly. Available from Eden Alternative Online
The Able Gardener: Overcoming Barriers of Age and Physical Limitations
by Kathleen Yeomans. Good Earth Publications, Columbus, NC.
About this Article
This article was edited for the National Center on Physical Activity
and Disability, a collaborative project of the National Center on
Accessibility, the University of Illinois at Chicago and the Rehabilitation
Institute of Chicago. NCPAD is headquartered at the Department of
Disability and Human Development, University of Illinois at Chicago,1640
West Roosevelt Road, Chicago, IL 60608-6904. NCPAD is funded by
the Secondary Conditions Prevention Branch, Office on Disability
and Health, Centers for Disease Control and Prevention. www.ncpad.org
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